June 12, 2005
JohnKarayan, Editor-in-Chief
The Journal of Interdisciplinary Studies
Department of Accounting, College of Business Administration
CalPolyPomona
3801 W. Temple Ave.
Pomona, CA91768
Hello John,
Attached are three copies of a revised submissionfor the coming Journal of Interdisciplinary Studies. I’ve made significant changes and renamed it to match terminology I used in a presentation at the American College Health Association annual conference this month.
JimGrizzell
Lecturer, Kinesiology and Health Promotion
909-856-3350 (voice), 909-392-0708 (fax)
Health and Academic Performance: At the Core of the University Mission
Abstract
The health of students, and its relationship to academic performance, is at the core of a university's mission. In the last few years university health decision makers have studied the reasons students say they have done poorly in academics and started re-organizing health services. Thehealth reasons for poor academic performance are different from health issues traditionally addressed by universities. It allows re-engineering resources and transforming attitudes and values to link university health services to the university mission. The alignment of resources gives more attention to health promotion and disease prevention to improve academic performance. National organizations urge core activities that are population-focused and less individual-focused to reduce health issues hindering achievement of the university mission. This paper describes changes in thinking about student health, the results of national studies and health services necessary for achievement of the university learning mission and student success.
Introduction
University decision makers are looking at university health service (UHS) activities and health determinants of academic performance in light of the mission of their institutions. This paper describessixdriving forces behind this new approach tocollege health. Presented are new national data on student health status and core activities health services will have to perform in their role of helping institutions of higher education excel in a competitive economy. Implementing programs to reduce stress, mental and emotional health issues, and colds and flu causing poor academic performance is an important determinant of competitive success.
Trends in social and economic issues and in higher education give decision makers many reasonsto re-evaluate the importance of activities UHSs perform for the university and students. These include awareness that the campus environment significantly affects health;results from national studies of health impediments to learning;standards of performance forcampus-community health education and promotion, and disease prevention; reduced resources; and measurable national student health improvement goals.
The most recent driving force is research data from the American College Health Association’s (ACHA) National College Health Assessment (NCHA) (ACHA, 2005). The assessment’s 44th question out of 55 lists 24 health problems and asks students to indicate (if applicable) how each caused them to do poorly in academics. The question determines what students considered as their causes of poor academic performance. Table 1 presents the results. Health impediments to learning are ranked in decreasing order.
Table 1
Students’ Health Reasons for Receiving Lower Grades or Dropping Courses
Health Impediments to Learning / Percent- Stress
- Cold/flu/sore throat
- Sleep difficulty
- Concern for family member or friend
- Relationship difficulty
- Depression
- Internet use / computer games
- Sinus infection/strep throat
- Death of family member or friend
- Alcohol
- Attention deficit disorder
- Injury
- Allergies
- Learning disability
- Chronic pain
- Drug use
- Chronic illness
- Eating disorders
- Mono
- Pregnancy
- Sexual assault
- Physical assault
- STD
- HIV
NationalCollege Health Assessment, Spring 2003, N = 19,497. (ACHA, 2005)
Another recent driving force is the realization by university student affairs leaders that the “effect of the campus environment and community on the individual health and well being is largely ignored” (National Association of Student Personnel Administrators (NASPA, 2004).Traditional thinking about health is focused on individual responsibility for maintaining health. NASPA’s “Leadership for a Healthy Campus: An Ecological Approach” calls for a shift in philosophy of campus decision makers. It uses a multifaceted view of health-related behaviors of students and groups. The approach considers the physical setting (geography, weather, architecture);characteristics of the people (events, rituals, diversity), organization(structure, policies and climate), and social climate of the community.
NASPA’s publication describes how to assess the environment, determine the most serious health concerns and prioritize them by the issues that have the greatest potential to cause the most negative consequences. NASPA also established a new significant interest group, the “Health in Higher Education Knowledge Community.” This forum provides a web page, listserv and discussion board for university leaders and staff to learn how to improve student health with an ecological approach.
Standards for health education and wellness are athird driver for considering the university mission. Two sets of standards are available. One is by the Accreditation Association to Ambulatory Health Care (AAAHC, 2000). The newest are the ACHA Standards of Practice for Health Promotion in Higher Education (SPHPHE) (ACHA, 2004).
AAAHC standards before 2000 only required that university health services meet the needs of patients(AAAHC, 2000). If the student was not a patient in the health center there was little need for a UHS to align its activities with the mission of the university. The new AAAHC standardsstate that health care organizations are encouraged to provide health education and wellness services to meet the needs of the population serviced. The number of characteristics and pages in the new standards devoted to wellness are comparable to other health services (e.g., dental, emergency, immediate/urgent care, pharmaceutical, medical lab, and x-ray). The new standards say the UHS is to assist in providing educational opportunities with a holisticapproach. The educational topics include:
- substance abuse prevention and education including alcohol, tobacco and other drugs;
- promotion of healthy eating;
- promotion of physical fitness;
- healthy sexuality education, including reproductive health, contraception, diseaseprevention, and skill building for healthy relationships;
- sexual, physical, and emotional violence prevention;
- promotion of and education about stress management and relaxation.
The standards in SPHPHE are designed to guide health promotion programming conducted by any university employee. There are six standards that require:
- Integration with the learning mission of higher education
- Collaborative practice
- Cultural competence
- Theory-based practice
- Evidence-based practice
- Continuing professional development service.
Within the six standards are 24 indicators. A companion document, Vision Into Action, provides individual and program assessments and program improvement planning tools.
The fourth driving force is a set of measurable health objectives from Healthy Campus 2010 (ACHA, 2000). Using NCHA data from 2000 national targets are available for the year 2010. Figure 2 shows the baselines and targets for the top ten health impediments to learning. Healthy Campus 2010 goals give university decision makers a way of seeing where their universities could be if evidence-based health improvement programs were implemented.
Figure 1
Healthy Campus 2010 Top 10 Impediments to Academic Performance
A fifth driving force for re-engineering UHS services is a low level of evidence showing that clinical care affects retention. Traditional models of health services emphasize the treatment of illness (NASPA, 2004) with the expectation that they will “facilitate the retention of students” (CSU, 2002). A review of the literature (ACT, DeBerard, Rummell), reveals that few students leave school or have academic impairments due to medical problems. DeBerard found that 0.6% of students left school for medical reasons. Campus retention specialists list medical problems among the least important reasons for leaving school (ACT, 2005). A UHS director and medical doctor with 35 years of experience in college health stated that in there is no documentation that campus clinics help retention (Turner, 2000).
A sixth driving force for re-engineering health services activities is the issue of
outsourcing. Traditional clinical health services may be considered mission neutral by university leadership, though access to quality health care, and, in many cases from UHS clinical services,is necessary (Turk, 1998). There is discussion several times each year on the Student Health Services’ email discussion list expressing concern about the interest of university administrators in reducing university costs by outsourcing. FrederickJ.Turk, president of ARAMARK Campus Services, notes that university leadership must identify the core activities that are mission and performance related, and creates value by making a difference in improving an institution’s academic, economic, and student development environment.
Turk states that health services must create value for the university by being a central part of the university in developing a holistic teaching and learning environment that adds to the student experience, and creates value by helping the institution achieve its unique mission to truly educate students. Campus services that perform core tasks well and tasks that are central to mission are less likely to be subject to outsourcing. Traditional UHS treatment services may not be core to the university mission but we should be remembered that insuring access to quality care is a Healthy Campus 2010 goal.
Discussion
Considering reasons health reasons, beyond medically treated problems, students do poorly in academics is new ground for decision makers.It represents a comprehensive view of health determinants of success (Fitzgerald, Johnston, Brignall, Silvestro, & Voss, 1992). The traditional view of college health is based on six major health risk areas described in Healthy People 2010(United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion (USDHHS-ODPHP, 2000).These cause over 70% of the illness, disability and deathsof adolescents and young adults. The risk areas are:
- injuries (unintentional and intentional);
- tobacco use;
- alcohol and illicit drug use;
- sexual behaviors that cause unintended pregnancies and sexuallytransmitted diseases;
- dietary patterns that cause disease; and
- inadequate physical activity.
Addressing these health issues does have a place in student development. Healthy People 2010 and Health Campus 2010 have national goals to insure access to quality health care for everyone. Most of thecategories listed above, however, are not the health reasons most students say they have poor academic performance. Monitoring the traditional health problems cared for by UHSs, therefore, may not be the most appropriate performance measures for UHSs. The American College Health Association (ACHA) and U.S. Department of Health and Human Services have ways to measure and set objectives for other health areas.
Healthy People 2010 lists additional health risk categories that need to be addressed. These are:
- environmental health (recognized influences on personal and community health);
- mental and emotional health;
- personal health; and
- consumer health.
Jackson and Weinstein (1997) state that “a healthy campus is one in which the healthrisks of a population are assessed and appropriate population-based interventions aredesigned and implemented to mitigate the impact of these risks. Since six of the top ten reasons forpoor academic performance can be related to stress the mental health and emotional health category should be a priority for UHSs. Education for prevention of colds, flu, and sore throat shouldbe given also; however, because between 70 and 80 percent of health related problems areeither precipitated or aggravated by stress (Pelletier, 1992), the emphasis should be on stress managementeducation.
Over the past 15 years Cal Poly Pomona’s health surveys indicatethat students rank stress management skills among the top health improvement strategies they would like to do more effectively. Another indicator of the importance of stress issues is that eachacademic stress management course taught at Cal Poly Pomona has a waiting list of studentswanting to get into the course. At Cal Poly Pomona, it is likely that less than 1,000 of the nearly18,000 get formal and comprehensive in education stress management skills each year.
It could be said that students just have to “deal with it.” The costsof stress, however, andstress related issues are in terms of academic performance and health care costs. Stresscauses less than optimal academic performance, weakens the university’s competitive position,and impedes success. Olpin (2000) suggests that when a person feels excess stress, the higherorder thinking levels tend to turn off. The stress response is a very low level thought processpattern. This results in mostly survival instincts rather than creative juices turning on. Perhapsstudents, under stress at times of testing and deadline forced projects, simply stop thinkingas well and, therefore, grades go down.
The dollar cost of stress aggravated or induced illnesses and injuries is high. Even if the
illness is a cold or flu, the cost of a single visit to a physician at a UHS averages over $90. As futureemployees, those unable to manage stress may have health care expenditures nearly 50percent greater than those are able to manage stress. The DHHS National Institute forOccupational Safety and Health (NIOSH, 2000) notes that 26 to 40 percent of employees saythey are very or extremely stressed on the job. The costs of occupational stress are $200 billioneach year. Between 60 and 80 percent of industrial accidents are stress induced and over 90percent of visits to doctors are stress induced. Possibly most striking is that workers'compensation claims related to stress result in 90 percent of claims being awarded insettlements (Seaward, 1999).
The UHS and university’s contribution to society is important. Healthy People 2010, states that “Health education and health promotion activitiesalso can be conducted in postsecondary settings and reach the Nation’s future leaders,teachers, corporate executives, health professionals, and public health personnel. Personalinvolvement in a health promotion program can educate future leaders about the importanceof health and engender a commitment to prevention.” Additionally, after graduation and asemployees with skills in managing stress, they are less likely to become as stressed asemployees are now and may be leaders in disease prevention and health promotion.
Students’ Perspectives
- Increased technology, more competition, and schedule overload affect the quality of student’s performance due to inability to manage their stress levels.
- College students may neglect their physical and emotional well being due to pressure to perform well in their classes, and lack of time management and stress management practices.
- Although proper nutrition, physical activity, various coping techniques and practices can enhance academic performance as well as health and well being, education programs are essential to implementing these practices.
As a non-traditional adult student I’ve felt that I had to deal with much more responsibility with family, finances, and other commitments than my fellow students. That is, until I discovered that many students of lesser years are struggling with equal demands on their time.
Exposure to the availability of advice and support in managing their time and stress levels would help students feel more confident in managing their health and well being as well as their grade performance.
AndreaM.Knatz, Dietetics Student, Human Nutrition and Food Science
______
- Stress management is the missing link to a successful college career, and life.
- Stress causes poor use of time.
- Poor use of time leads to poor performance.
- There is an intense mind body connection with stress, and when stress is managed properly it makes for a more productive mind and body.
What most students don't realize is that stress causes more damage then just mental breakdowns mid-quarter. They don’t understand that there is an intense mind body connection with stress and with proper management techniques they can use their time more wisely and take an active role in making themselves healthier.
With KIN 370, Stress Management for Healthy Living, an online synthesis course, there is relief in site for stressed out students, and early education is the way to avoid heart attacks caused by stress down the road. Just like anything else the earlier you know, the better – and with stress if you can learn how to manage it when you’re young you will lead a much healthier and successful life.
The university should promote more stress management skills through more classes offered on the topic. These classes should not be limited to seniors who have completed all their GE’s in one area or incoming freshman – it should be available for all students; it should be encouraged for all students at the university.
Aimee Holliday – Communications Major
Other traditional health education issues have been addressed more thanstress management, and mental and emotional well-being. NCHA data indicate that nearly half of students have receivededucational information about alcohol and other drugs, sexually transmitted infections, andHIV and AIDS from their universities. The only stress related health information item, suicide prevention, is addressed poorly by universities. Only 12% of students say they have received information about preventing suicides.
Reducing stress can be done effectively with NASPA’s recommended ecological approach. ArizonaStateUniversity (Moses, 2005) uses the tools in “Leadership for a Healthy Campus.” Based on focus groups and surveys ASU has determined campus determinants of stress and is making place, people, organization, and policy changes to reduce student stress. Other recommendations are to have all students required to take stress management courses early in their academic careers. A reinforcement strategy is the health promotion tool of social marketing conducted throughout the students’ life on campus to remind them of the skills learned in the stress management course.